Download Provider Notice for Standard Children Co-pays

STATE OF TENNESSEE
DEPARTMENT OF FINANCE AND ADMINISTRATION
DIVISION OF HEALTH CARE FINANCE AND ADMINISTRATION
BUREAU OF TENNCARE
310 Great Circle Road
NASHVILLE, TENNESSEE 37243
This notice is to advise you of information regarding the TennCare Pharmacy Program.
Please forward or copy the information in this notice to all providers
who may be affected by these processing changes.
TennCare policy has not changed, but Magellan, the pharmacy benefit manager, has failed to collect co-pays and will begin doing
so. As a result, some TennCare enrollees may notice a difference in the co-pays they will pay at the pharmacy. We encourage you
to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional
questions.
Some TennCare Medicaid Children May Notice a Difference in Co-pays for Medications
TennCare Medicaid children (defined as less than 21) are not subject to co-pays unless they are at or above 100 percent of the
federal poverty level (defined as TennCare Standard Children). Exceptions include:

Pregnant women; and

People receiving hospice care.
Note: Pregnant women and people receiving hospice care need to self-declare at the pharmacy in order to be exempt from the copay. The pharmacy may override the co-pay for a pregnant recipient by submitting a “2” in the Pregnancy Indicator field
(NCPDP Field # 335-2C). The pharmacy may override the co-pay for a recipient in hospice care by submitting an “11” in the
Patient Residence field (NCPDP Field # 384-4X).
Starting on September 1, 2016, some TennCare Medicaid children who fall within the TennCare Standard Children group may
notice a difference in co-pays assessed on pharmacy claims. The co-pay structure for TennCare Standard Children is defined
below.

Brand name medications have a $3.00 co-pay per prescription.

Generic medications have a $1.50 co-pay per prescription.

Family planning drugs are not subject to the co-pay.

A claim for a multi-ingredient compound is $3.00 co-pay per prescription.
This information is available to enrollees as a part of their TennCare Benefits package. Please
refer them there for more information.
Helpful TennCare Internet Links:
Magellan: https://tenncare.magellanhealth.com
TennCare website: www.tn.gov/tenncare/
Please visit the Magellan TennCare website regularly to stay up-to-date on changes to the pharmacy program.
Thank you for your valued participation in the TennCare program.
-Page 1 of 108/09/2016